| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $70 | $70 | $70 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $467 | $467 | $467 |
| Excision chalazion single CPT 67800 • Ophthalmology | $20 | $20 | $20 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $61 | $61 | $61 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $30 | $30 | $30 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $4 | $4 | $4 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $128 | $128 | $128 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $43 | $43 | $43 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $33 | $33 | $33 |
| Visual field examination CPT 92083 • Ophthalmology | $30 | $30 | $30 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $35 | $35 | $35 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $20 | $20 | $20 |
| Fundus photography CPT 92250 • Ophthalmology | $32 | $32 | $32 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $22 | $22 | $22 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $3 | $3 | $3 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $28 | $28 | $28 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,440 | $1,440 | $1,440 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $201 | $201 | $201 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,071 | $1,071 | $1,071 |
| Total shoulder replacement CPT 23472 • Orthopedics | $854 | $854 | $854 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $950 | $950 | $950 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $249 | $249 | $249 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $44 | $44 | $44 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $350 | $350 | $350 |
| Total hip replacement CPT 27130 • Orthopedics | $108 | $108 | $108 |
| Hip replacement conversion to total CPT 27132 • Orthopedics | $986 | $986 | $986 |
| Open treatment femoral fracture CPT 27236 • Orthopedics | $705 | $705 | $705 |
| Treatment intertrochanteric femoral fracture CPT 27244 • Orthopedics | $725 | $725 | $725 |
| Treatment intertrochanteric fracture with plate/screw CPT 27245 • Orthopedics | $1,035 | $1,035 | $1,035 |
| Partial knee replacement medial or lateral CPT 27446 • Orthopedics | $145 | $145 | $145 |
| Total knee replacement CPT 27447 • Orthopedics | $108 | $108 | $108 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $344 | $344 | $344 |
| Closed treatment distal fibula fracture CPT 27786 • Orthopedics | $41 | $41 | $41 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $148 | $148 | $148 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $108 | $108 | $108 |
| Arthroscopy shoulder rotator cuff repair CPT 29827 • Orthopedics | $452 | $452 | $452 |
| Arthroscopy knee with meniscectomy medial and lateral CPT 29880 • Orthopedics | $239 | $239 | $239 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $46 | $46 | $46 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $439 | $439 | $439 |
| Arthroscopy knee ACL repair CPT 29888 • Orthopedics | $412 | $412 | $412 |
| Discectomy lumbar single level CPT 63030 • Orthopedics | $383 | $383 | $383 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $927 | $927 | $927 |
| Carpal tunnel release CPT 64721 • Orthopedics | $187 | $187 | $187 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $7 | $7 | $7 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $43 | $43 | $43 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $13 | $13 | $13 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $161 | $161 | $161 |
| Spinal cord stimulator electrode implantation CPT 63650 • Pain Management | $285 | $285 | $285 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $17 | $17 | $17 |
| Plantar common digital nerve injection CPT 64455 • Pain Management | $31 | $31 | $31 |